Loss to Follow-up in the Hepatitis C Care Cascade: A Substantial Problem but Opportunity for Micro-elimination

A Substantial Problem But Opportunity for Micro-elimination

Marleen van Dijk; Joost P.H. Drenth


J Viral Hepat. 2020;27(12):1270-1283. 

In This Article

LTFU During Liver Disease Assessment (CHCoC Step 4)

Several diagnostic procedures are available to grade and stage liver disease. Where liver biopsy was standard of care in the past, nowadays noninvasive methods are largely preferred. Liver fibrosis may be quantified by using serological panels, such as the widely used FIB-4 (using the patient's age, platelet count, AST and ALT levels) or APRI score (using AST levels, the AST upper limit of normal and platelet count), or by using transient elastography. Almost all studies in the DAA era employ noninvasive ways to assess liver disease severity. When looking at people who have attended their first visit after being diagnosed or referred, fibrosis was assessed with the APRI scoreSuppl file 2,24,33 in 52%-99% (median 87%) and with FibroScanSuppl file 9,12,22,25,27,30,34,35,40,41,50,53 in 59%-100% (median 79%). Studies which used other noninvasive measures or did not report which measures were used, reported assessment in 48%-95% (median 88%) of attendees.Suppl file 20,21,25,26,36 LTFU may contribute to this suboptimal assessment rate and should be addressed.